NCMA217: CARE OF MOTHER AND CHILD AND ADOLESCENT (WELL CLIENT)

WEEK 2: BREAST, PELVIS, AND FETAL SKULL

PROFESSOR: FRANCIS A. VASQUEZ, MAN, RN
1ST SEMESTER | A.Y 2023 – 2024 | TRANSCRIBER: RIZALYN RANGEL DIAVARRO

OUTLINE Prolactin
I. Breast: Mammary Glands
a. Internal Structures - hormone that stimulates production of milk; comes from the
b. Mammary Glands and Milk Ejection anterior pituitary gland
Reflex
II. Pelvis
a. 2 Divisions Oxytocin
b. 3 Parts of the True Pelvis
c. 4 Types - hormone that causes let-down (push out milk) reflex; comes
d. Boundaries of the True Pelvis from the posterior pituitary gland
e. Diameter
f. 6 Mechanisms of Labor and Delivery
III. Fetal Skull-Pelvis Relationship Cooper's ligament
IV. Fetal Skull
a. 3 Main Bones - keeps the firmness of the breast
b. Sutures
c. Fontannels
d. Regions
Acinar/Acini cells
e. Fetal Presentation
f. Attitudes - cells found inside the lobes responsible for milk production
g. Fetal Lie
h. Fetal Station
i. Fetal Positions
j. Auscultation Sites For proper latching or sucking, the newborn baby must
suck up to the areola.

BREAST: MAMMARY GLAND

Upper portion
- part of areola that is partially visible when the baby is
sucking the breast of the mother

MAMMARY GLANDS AND MILK EJECTION REFLEX

When the mother is doing breastfeeding, its advantage is

having uterine contractions which promotes start of
involution, and prevents postpartum bleeding and formation
of blood cloth.

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 Infection Cavity
- complication if the blood cloth did not release outside of - no boundaries because it is a space inside
the uterus.
Outlet
- bounded anteriorly by inferior pubis, posteriorly by coccyx,
Self-breast examination and transversely or laterally by the ischial spines (sipit-
sipitan)
- is done 5-7 days after menstruation

4 TYPES
PELVIS

- Supports and protects the reproductive and other

pelvic organs
Gynecoid

2 DIVISIONS - true female pelvis; well-rounded; can support pregnancy,

labor and delivery
False Pelvis
Android
- supports the growing uterus; guides the baby towards the
birth canal - male pelvis; heart or triangular shaped

True Pelvis Anthropoid

- serves as the birth canal - oblong; can also support pregnancy, labor and delivery
Platypelloid

3 PARTS OF THE TRUE PELVIS - flat pelvis; has a narrow AP diameter

BOUNDARIES OF THE TRUE PELVIS

Inlet
- bounded anteriorly by superior pubis, posteriorly by sacral Engaged/Engagement
prominence, and transversely or laterally by the ilium
- the baby's head is stuck between the ischial spines

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 DIAMETER OF THE PELVIS Fetal Skull - most important part because:

 Most frequent presenting part

 Largest part of the fetal body
 Least compressible

FETAL SKULL

AP diameter
- anterior to posterior
Transverse diameter
- ilium to ilium
3 MAIN BONES
Oblique diameter
 Frontal Bones
- diagonal  Parietal Bones
 Occipital Bones

Since inlet, cavity, and outlet vary in size, the fetus needs
to rotate while passing the birth canal. The head is trying to SUTURES
look for an area where it will fit.
- cranial joint
Frontal suture
6 MECHANISMS OF LABOR AND DELIVERY
- between 2 frontal bones
- movement rotation of the baby while passing the birth Coronal suture
canal
- between 2 frontal bones and 2 parietal bones
D - escent
F - lexion Sagittal suture
IR - internal rotation
- between 2 parietal bones
E - xtension
ER - external rotation (restitution) Lamboidal suture
E - xpulsion
- between 2 parietal bones and occipital bone

FETAL SKULL-PELVIS RELATIONSHIP

FONTANNELS
- will form if you connect the different sutures
Anterior fontannel
- diamond-shaped; bigger; will close 12-18 months
Posterior fontannel
- triangular-shaped; will close first after the delivery (2-3
months)

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 REGIONS OF THE FETAL SKULL - fully hyperextended; face

If the presenting part is the face, the mother will undergo

cesarean because it can cause cervical fracture if normal
delivery.

FETAL PRESENTATION

Face-Mento-Vertical Diameter
- biggest (13.5 cm)
- presenting part is the face, and the landmark will be the
chin
Brow/Sinciput
- big
Vertex Cephalic

- small - most ideal because it is heads first; if the baby is in cephalic

presentation, it doesn't mean to say that labor and delivery
Occiput will be normal because it depends on the presenting part
- Subocciput bregmatic (SOB) Breech
- smallest (9.5 cm) - buttocks first
- should enter the inlet and goes out of the outlet first; most Transverse
common diameter that is presented
- baby is sideways

ATTITUDES
FETAL LIE

- degree of flexion (yuko) and extension (tingala) of

the fetal head - relationship of the long axis of the uterus and long
axis of the fetus

Flexion
- partially flexed; vertex Longitudinal

- fully flexed; occiput - parallel to one another; cephalic and breech; most ideal lie

Extension Transverse

- partially hyperextended; brow/sinciput - diagonal or oblique lie

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 Presentation together with the amniotic fluid making it the first to go out,
which is called Cord prolapse.
- most commonly used terminology when you communicate
inside the labor and delivery room
Problem: If the mother is experiencing Cord prolapse, what
are the don’ts in Cord prolapse?
FETAL STATION
Answer:
1. Don't allow the cord to dry.
2. Don't allow the cord to further go out.
3. Don't push back or reinsert the cord.

Maternal positions to prevent the cord

from coming out:
Maternal Landmark: Ischial Spines
 Knee-chest (Genupectoral)
-5  Dorsal recumbent but with pillow under the buttocks
 Trendelenburg
-4
-3
FETAL POSITIONS
-2
- relationship of the Maternal Pelvic Quadrant to
-1
Fetal Landmark
At Level of Ischial Spines = station 0 = engaged
+1 Right Right Mento Right Sacro Occiput
Occiput Anterior Anterior Anterior
+2 Anterior (RMA) (RSA) (OA)
(ROA)
+3
Left Occiput Left Mento Left Sacro Occiput
+4 Anterior Anterior Anterior Posterior
(LOA) (LMA) (LSA) (OP)
+5
Right Right Mento Right Sacro Mento
Occiput Transverse Transverse Anterior
1 station = 1 cm Transverse (RMT) (RST) (MA)
(ROT)
Left Occiput Left Mento Left Sacro Mento
Ballottement
Transverse Transverse Transverse Posterior
- the baby is covered with amniotic fluid (LOT) (LMT) (LST) (MP)

Right Right Mento Right Sacro Sacro

Occiput Posterior Posterior Anterior
Problem: -2 cm station, 5 cm dilated fully effaced cervix, and Posterior (RMP) (RSP) (SA)
the bag of water ruptured. What possible (ROP)
problem/complication do you expect to happen?
Left Occiput Left Mento Left Sacro Sacro
Answer: Cord prolapse Posterior Posterior Posterior Posterior
(LOP) (LMP) (LSP) (SP)
Explanation: If the head of the baby is 2 cm above ischial
spines, the head is not yet engaged. If the head is not yet
engaged, there is a space between the head and the ischial
spines. The cervix is already dilated and the bag of water
already ruptured which leads to the umbilical cord going

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 OP, ROP, LOP
- mother will experience more back or lumbosacral pain
during labor and delivery, and has a tendency to experience
lacerations

3 Common Presenting Parts

 Occiput – triangular △; same side

 Face - mento (chin) ∧; opposite side
 Buttocks - sacro (sacrum) ʍ; same side

Auscultation Sites

 LOA – LLQ
 ROP – RLQ
 OA – MLQ
 LMP – RLQ
 LSA – LUQ

posterior - the baby is facing the abdomen

anterior - the baby is facing back from the abdomen

LOA
- most common fetal position

OA, ROA, LOA

- most ideal fetal positions

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